Provider Demographics
NPI:1174791156
Name:DIABETES AND NUTRITION MANAGEMENT OF BARDSTOWN, PLLC
Entity type:Organization
Organization Name:DIABETES AND NUTRITION MANAGEMENT OF BARDSTOWN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETICIAN/DIABETES EDUCATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LD,CDE
Authorized Official - Phone:502-349-0160
Mailing Address - Street 1:120 W STEPHEN FOSTER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1465
Mailing Address - Country:US
Mailing Address - Phone:502-349-0160
Mailing Address - Fax:502-349-0170
Practice Address - Street 1:120 W STEPHEN FOSTER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1465
Practice Address - Country:US
Practice Address - Phone:502-349-0160
Practice Address - Fax:502-349-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0112133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYRD00009Medicare PIN